Provider Demographics
NPI:1902863129
Name:DANIELSON, CONSTANCE (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 BARNHILL DR
Mailing Address - Street 2:A128
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5126
Mailing Address - Country:US
Mailing Address - Phone:317-274-4806
Mailing Address - Fax:
Practice Address - Street 1:635 BARNHILL DR
Practice Address - Street 2:A128
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5126
Practice Address - Country:US
Practice Address - Phone:317-274-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033744A207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine